Using Script Concordance Testing (SCT) to Assess Clinical Reasoning- The Progression From Novice to Practising General Practitioner


Script Concordance Testing (SCT) is a relatively new modality of assessing clinical reasoning (CR). Candidates are presented with a clinical scenario, followed by a new piece of information. The candidates are then asked to assess whether this additional information increases or decreases the probability of the suggested provisional diagnosis, or the usefulness of an investigation or management option. The candidate’s decision is compared to that of a reference panel of experts. However, studies looking at the progression of CR from medical student to practising clinician are lacking. In 2012, the School examined105 final year students using 40 SCT questions based on 15 case scenarios. The same batch of questions was given to 13 practising GPs who were PBL tutors. The mean and standard deviation of the scores of both groups were analysed. Student t- test was used to look for any statistical difference. The student cohort mean score and standard deviation were 64.9% and 6.4% respectively. The GP group’s mean score and standard deviation were 70% and 8.6% respectively. The t-test performed was statistically significant at P=0.013. There seems to be a significant progression of the CR skills from the medical students at the novice level to that of practising GP clinicians, reflected by the higher scores in the GP group attempting the SCT questions. Applying the same SCT exercise to a group of GP trainees (fellows in training) may provide additional insight into the progression of CR with clinical experience.

Figure 1 Comparison of the mean and SD between MED4000 students and GP Group Tutors.


script concordance testing, clinical reasoning, progression

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